1506 JORDAN ST PLRS19-0060 SEWER REPL PERM . I- . -7
PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH PLRS19-0060
v~ 800 SEMINOLE ROAD ISSUED: 3/22/2019
ATLANTIC BEACH, FL 32233 EXPIRES: 9/18/2019
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
ALL WORK • • ' TO THE CURRENT EDITION1 OF •
CODE, NEC, IPMC, OF • OF ORDINANCES .
ALL CONDITIONS OF PERMIT APPLY, PLEASE READ CAREFULLY.
NOTICE: In addition to the requirements of this permit,there may be additional restrictions applicable to this property
that may be found in the public records of this county,and there may be additional permits required from other
governmental entities such as water management districts, state agencies,or federal agencies.
JOB ADDRESS: PERMITTYPE: DESCRIPTION: VALUE OF WORK:
1506 JORDAN ST PLUMBING RESIDENTIAL sewer replacement $1000.00
TYPE OF BUILDING
• • GROUP:
172295 0000 ED SMITH S/D
• ADDRESS:
JOHN MOON PLUMBING 1103 PALM OR JACKSONVILLE FL 32250
BEACH
_ • .� ADDRESS:
Duncliff Trading Company 4240 FULTON AVE #112 Atlantic Beach FI 32233
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT
IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF
COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST
INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN
ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
LIST OF CONDITIONS
Roll off container company must be on City approved list. Container cannot be placed on City right-of-way.
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
PLUMBING BASE FEE 4SS-0000-322-1000 0 $55.00
PLUMBING FIXTURES 4SS-0000-322-1000 1 $7.00
STATE DBPR SURCHARGE 45S-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 4SS-0000-208-0600 0 $2.00
TOTAL:$66.00
Issued Date: 3/22/2019 1 of 2
Plumbing Permit Application **ALL INFORMATION
HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
n
800 Seminole Rd, Atlantic Beach, FL 32233
Phone: (904) 2477--"5826 Email: Building-Dept@coab.us PERMIT#: P(-V&g--W ea
JOB ADDRESS: l S;D& �1[)aL PROJECT VALUE $
❑NEW OR REPLACEMENT INSTALLATION and/or ORE-PIPE
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub Septic Tank & Pit
Clothes Washer Shower
Dishwasher Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory Water Heater
Other Fixtures Water Treating System
❑MISCEL�►NEOUS
ewer Replacement
❑ Back Flow Preventer
❑ Lawn Sprinkler System (number of sprinkler heads)
❑ Grease Interceptor(Trap) gallons (Requires 3 sets of plans)
❑ Well **SJRWD Well Completion Form.Completed form to be submitted to the Building Department for final inspection.**
ii Other
Permit becomes void if work does not commence within a six month period or work is suspended or abandoned for six months.
I hereby certify that I have read this application and know the same to be true and correct. All provisions of laws and ordinances
governing this work will be complied with whether specified or not. The permit does not give authority to violate the provisions
of any other state or local law regulation construction or the performance of construction. �"/
Owner Name: (d (�/ 6A, �/"N 1 e s, � r,�hone Number: d4� �Y�t a—1e7�(o
Plumbing Company: ;rc,/74. 4 d2,Z12 &"7 Phone: � �cl Fax
Co. Address: 24 D City: A &f'l— State:&Zip: 3 Zy�3
License Holder: State Certification/Registration # EGD/200y
Notarized Signature of License Holder
The forego i instrument was acknowledged before me this c Aay of 4a 20 )9, in the State of Florida,
County of LkVctj
_ Signature of Notary Public l/
Q �2 -��►J
JOSETTE A RETHMEL
_•; Commission#FF 218261 [ j Personally Known OR [ J/P duced Id�jntification
a Expires April 7,2019 Type of Identification: A.� (_�f•I��t S U Cama. —
'�: Banded Nu Tr0Y Fein Inma w,DD3B mis
Updated 10/17/18